Hello, hi, as, Paul said, I'm Kate Jones from Miller. I'm the marketing manager at Mila Professional, we are the commercial arm of the white goods manufacturer, and we've been providing commercial equipment in the UK. For over 50 years to a variety of businesses including care homes, laboratories, hotels, and veterinary practises as well.
Obviously over the next hour you're gonna be listening to Danielle talking about diarrhoea and kittens, but it seemed a good fit for us to briefly talk to you about how laundry can impact on infection control as well. So over the next couple of minutes I'm just gonna talk through some, some key points from our side. So why does laundry matter when it comes to infection control?
Obviously mud, blood, faeces, and vomit all in inevitable part of your day to day working life, and infection can easily be spread. Infections can live and spread on scrubs, animal bedding, towels, uniforms, and the threat of cross contamination is very real. So therefore, the type of laundry machines that you use and the temperature that you wash items at is crucial when it comes to disinfecting items.
What we have found, is a lot of vets do use domestic machines, so part of why I'm talking today is obviously talking about the benefits, of a commercial machine. Over the domestic machines. One of the, the key points, is the important guidelines for the care sector, which is also applied as best practise for veterinary practises as well.
These are the health technical memorandum guidelines, around decontamination of line. And they state to kill bacteria, linen should be thermally disinfected using washing cycles that achieve 65 degrees for at least 10 minutes, 71 degrees for at least 3 minutes, or 82 degrees for at least 1 minute. And there are also other regulations to consider, the main one being the water regulation advisory scheme category 5.
This means that any water fitting, that's attached, there basically is an air gap in between where the water comes in and where the drum, where the cycle takes place, so that the contaminated water can't then flow back into the mains water supply. These air gaps only apply to commercial machines. Domestic machines don't have, this air gap, and therefore they're not approved by the Water regulation advisory scheme to be used in the best practise, .
Especially with the animal waste that's that's involved. Another factor to consider is cycle times. So, professional, a me a professional machine can wash and dry in 85 minutes, a 6.5 kg load of laundry, whereas a domestic, you're looking at, around 210 minutes just for washing, for both drying, but 120 just for washing.
We, as I said, we have recently surveyed, 100 vets to find out more about laundry procedures and what the biggest concerns were when it came to infection control. What we found was that almost half the vets have a domestic washing machine, and again, almost half have a domestic tumble dryer as well. And obviously this is key for us to know because, as I mentioned, there are factors involved in using domestic washing machines in a commercial.
Premise, and 50, 56% of vets believe that their current washing machine is effectively killing infectious diseases. When we're looking at a laundry room layout, obviously we've got our commercial machines here. They take up the same space as a domestic machine.
These are our little giants, so they have a less than 1 metre squared, footprint. And in your work environment, the reliability of these machines is key as downtime obviously has to be limited. So having the correct drain option on the machine will eliminate the risk of blockages, and the build up in the pipes.
So this, this is called a, a drain valve machine basically has a trap at the bottom, which opens up entirely to empty all the water and foreign objects from the drum. So that things like animal hair, etc. Can, can go straight down.
In this situation we've got a tumble dryer stacked on top. They can obviously go side by side as well. And we've got space in the laundry room for folding tables, racing, and lorries, trolleys.
And finally, the, sorry, finally, the laundry room should have a sink or facility to wash your hands, after handling the soiled linen. So what are the benefits of a Miller commercial machine? We're a German company, so testing is our business.
Quality is very much at the heart of, everything, Miller. Our washing machines are tested to last for 30,000 cycles, and our dryers are tested to 40,000 cycles. And if you equate that to day to day life, that's running 8 cycles a day, 7 days a week for approximately 12 to 15 years, whereas the domestic appliance, is expected to last for approximately 5000 cycles in a domestic, situation.
So with heavy use, regular cycles, it can last as little as 18 months. The honeycomb drum is a USP of Mila, so this cushions the laundry, in the, in the middle, so it means that linen quality life is preserved. We have a sluice programme option, obviously in compliance with the health service guidelines that I've just mentioned.
And importantly, our, commercial machines are supplied as standard with 2 years parts and labour for commercial practises. Domestic machines don't come with any parts and labour. For commercial, if they're used in a commercial setting, so that's important to know as well.
And then obviously, due to the low operating time, the, the, the short cycles, a large amount of electrical energy and water is saved, and, and, you know, makes it efficient, and this relates to, the government's water technology list where they choose machines which have proved to be water efficient. And this enables your practise to write off the whole cost of the equipment against taxable profits of that year. So, so a key benefit to consider as well.
There are several other, additional equipments that, piece of equipment that Mila offers. So obviously an additional Little Giant machine could be used for tea towels or, or, items that aren't used for the animals, so having a separate laundry machine. Having a dishwasher, one for the animal kitchen, for bowls, and one for the staff kitchen, and then we do do a range of, washer disinfectants as well for, all the other areas that you need them.
So that was a very brief synopsis from me. Thank you for your time. We do have a dedicated page on our website where we, where we have a host of .
Information on infection control. We're launching a new infection control guide this week. It will be up there today.
If you need it, you can't find it, then just give me an email and I can send it across to you. Please let me know if there's any other questions at the end of the, webinar, but I think I'll pass it over to Danielle now for your, your main webinar. Thank you.
OK. Good question. Where's it just disappeared to?
Oh, there it is. OK. So, wonderful to be back with you all.
I hope, that was useful. Certainly, the difference between what, Miller products can do and some of the others, I really hadn't realised, so I can see that it really should make a big difference to us. And it does fit nicely with the talk that I'm doing today, which is diarrhoea and kittens, otherwise known as my squitty kitty talk.
You know me, I always give them cute talks, cute names. So we're gonna really focus on diarrhoea and kittens, most likely causes. And you know me, I'm gonna put it around cases because I just find it easier to learn with cases, and I hope you do too.
So the causes, the most common causes of diarrhoea in kittens are gonna be dietary or infectious. The other causes are much less common. And when we're talking about dietary, usually that's gonna be a change in diet, maybe weaning.
Indiscretion, milk or milk-based products can be intolerance, hypersensitivity. Certainly, if you see inflammatory bowel disease or what appears to be inflammatory bowel disease in kittens, then it is much more likely to be or in young cats, so 6 months less, much more likely to be diet related than than other causes. Infectious disease, really common and obviously it does depend where in the world you might be, but the most common causes of diarrhoea and kittens generally are going to be tratrachomonas foetus, Toxocara toxicara catty.
Cytos cyto zoo. I always knew this is asos. I grew up with it as being azos.
I don't know about you. I find all the taxonomy changes are really frustrating. It's like, why did they keep doing it?
I have to keep learning new names. I can't spell them. And, feline panopenia virus, feline arvo virus would be its other name.
We do see intersceptions, and that can be related to heavy worm burdens in kittens or foreign bodies as well. Partial partial gut obstructions that is usually foreign bodies because you know what kittens are like, they will pick things up in their mouths and and sort of them. As I said, IBD really not such a big thing in kittens and neoplasia would be very unlikely.
And generally, you can divide causes of diarrhoea and intestinal and extra intestinal. And if we're looking at the extra intestinal, then really the most likely are gonna be the polysystemic infections. So you like pavo, I tend to call it pavo because that then just makes you realise that cat pavo and dog pavo are exactly the same.
FIP, so feline infectious peritonitis, toxoplasmosis, and salmonellosis. So they'll be ear infections, but don't forget your toxins and drugs and particularly antibiotics. Antibiotics in kittens is a really good way of completely trashing their gut microbiome to the point that you can have a kitten that you never get from them again.
So do not reach for antibiotics lightly when you're dealing with kittens or puppies, you know me, I don't deal with the lesser species. And we must mention these other systemic diseases can be involved, but you, you know when you're dealing with those. So I want to select little tidbits about infections.
So with the viruses, then yeah, feline parvo, but we also see what looks identical to feline parvovirus, feline panicopenia virus caused by canine parvovirus. OK. And in one study, we did, we found that let me see if I get the pointer.
There we go. There's a pointer. In one study we did, 22% of cats with diarrhoea in Britain did have one of the other viruses in their faeces.
These were cats with diarrhoea. The coronaviruses, yep, they're pretty important and obviously you can have the enteric form or the mutated form because FIP certainly can cause diarrhoea as well. Look how common this was in the IDE study.
Well, clearly all these cats aren't dying from FIP, and I don't believe that actually enteric coronavirus is causing their illness either in a lot of cases. Unfortunately, an awful lot of kittens, particularly if the pedigree or resco, they've got these viruses in their faeces. So that, how on earth do you interpret that?
I'm sure most of you will have seen Tora virus, which is otherwise known as third eyelid prolapse and diarrhoea virus, really catchy name, isn't it? But that's what it says on the tin. Those cats usually spontaneously resolve, but the diarrhoea does.
The rotors and astros, you find these regularly, but whether they're truly causes of diarrhoea, we're not sure. Certainly, a new infection with feline leukaemia virus can be devastating and, and. Of the helmets, people get really excited about worms causing diarrhoea.
They really don't cause diarrhoea in adult cats at all. And in kittens, they certainly can, and we always need to make sure that the cats kittens have been wormed because we don't want to leave something that pretty easy to treat, untreated, but really, they're not big players. So Oluanus is the, stomach worm, so that's not gonna cause diarrhoea.
And then you've got tapeworm and the round worms that say they really don't cause much diarrhoea. Where you will see it will be usually a little rescue kittens, and you see them and they always call them little wormy kittens. They've got big distended bellies, and they're quite often thicking up writhing pools of worms and you see them in the faeces.
But we mustn't ever forget those and, and, and miss a chance to treat them. A protozoa, these guys, these become much more important because a lot of these are also potential zoonosis, so risk to us, but also risk of nocomal infection, I spreading to other cats, other dogs, you know, other species within the clinic situation. And, and that's where hygiene's gonna be really important.
When we're talking about Gryptosporidium, it is really feelless in cats rather than parm. And it can be anything from, actually all of these, anything from completely as the asymptomatic carriage to pretty bad diarrhoea. And you can see the sort of level of carriage that we can see.
Giardia is certainly again asymptomatic to severe diarrhoea, . Crypto tends to be a little bit more large bowel, Giardia tends to be a little bit small bowel. Isosor, I can't get into its new name.
Please forgive me. This tends to be more large bowel. And you certainly do see this quite a bit I see in rescue kittens, and certainly toxoplasmosis could do it, but it would usually be with a systemic infection and that's going to be a very sick.
The bacteria again, potential zoonosis and nosocomial infections. You've got campy. Campy is a funky one.
I love camping because there's a great study that showed that actually cats without diarrhoea in one study were more likely to have Campylobacter than cats with diarrhoea. So from that study, you could actually say that Campylobacter was protective. So that kind of tells you everything we don't know about campy.
And asymptomatic carriage, incredibly common. But the problem is, it can also cause disease and it can be zoonotic. It does depend, say with, with Giardia and with campy, that the, the strains or assemblages in Giardia's case, they're not always infectious to humans, but occasionally they can be.
Mustn't forget about salmonella. It is not common. It was only 1% in the big study that we did, but in one study of kittens in a rescue centre, then it was up to 18%.
And obviously that is a pretty big pathogen. It can also be an asymptomatic carriage. It's just not fair, is it?
And then we've got Clostridium again, it can cause anything from asymptomatic car getting the picture, aren't you really frustrating. And then there's a few E. Coli, hard to know exactly how important that one is, and we've got others which are are much rarer.
I think it's important, and I, I, I put Milly on the, the, the slide. I'm sure they'll forgive me for doing that because I wanted to highlight it. It's very important when we're dealing with kittens with diarrhoea, to alert the owners to the fact that the kitten could be shedding something, even if it's not the cause of the kitten's diarrhoea.
It could be shedding a potentially zoonotic, infection. And so if there's anyone within that home, so for example, here, this, this big guy looks pretty fit, he's covered in kittens, and gorgeous picture, although he could do with more hair. That's me being biassed.
My, my husband's got long hair and beard. I'm, I'm like that. So, you know, we do need to always ask the owners.
Are there anyone in the household? Is there anyone who might be immune suppressed? Because salmonella, Clostridium, Cryptosporidia, say some of the strains of Gardia that cats carry, not all of them, by a long shot, and the same way with with Cay.
And certainly, if you get some of the really toxic E. Coli, then that could certainly be a problem. Tragiccommonas, interestingly, very, very rarely goes to humans.
There's not many cases in humans, but it has been reported and it can go to dogs. So that's on those coal risk. Helicobacter are the same, and mycobacteria not a common cause of diarrhoea and certainly not in kittens, but if I put my other hat on, that's obviously an area I do a lot of research on.
So it is very important when you're dealing with kit kittens that have got diarrhoea, particularly with some of the conditions like trichomonas foetus, which can cause faecal incontinence and regularly does. You have got to really consider hygiene. You have got to consider the risks to nurses, vets, other patients, and when those cats go home to their owners and the rest of the family.
And certainly for Tritrex, I do regularly hospitalise these cases for their treatment, where the, the family have toddlers or things like that, because these cats can be dripping poo all over the place. I saw two kittens that were brought in by a GP. She and the kittens were all covered in poo, and at the end of the consult, my consult room was covered in poo, and I must say, I didn't really fancy being her patient.
Other things you want to think about feeding, non-raw food, because any kittens fed raw food, there is a potential risk. It's very, very hard to, to access, raw raw meat that doesn't carry, salmonella, Campylobacter, even, Listeria, let alone. A few of the helmets and things.
So the kittens that is something that worries me. And if I've got a kitten that has got diarrhoea, then I have to worry, particularly if it's a raw food fed, even if it's not the diarrhoea is not being caused by that particular infection. The cat is a much bigger risk than of actually shedding it and infecting the environment, and actually being able to in that environment as well as best possible.
I think the rest speaks for itself and to underline the nosocomal risks where we're talking about spread within the clinic, either from cat to cat or cats to dogs, a good reason, as far as I'm concerned to never have cats and dogs in the same ward, if possible, because I always point out that parvovirus in the dog will happily infect cats and cause what looks identical to panleuopenia. And certainly most of the enteric, bacteria and the, the, a lot of the protocell are all of these guys, we've got to be thinking about those. And here I direct you to the CDC guidelines.
That's the centre of disease control. That will list what what is classically deemed an immunocompromised individual. So that's children, pregnant people, elderly people, people on chemotherapy, people on any drugs that are immunosuppressive, you know, the the the the standard at list that you you're quite well aware of.
Interestingly, when you are rehoming, it gets to in immunosuppressed, people, the CDC, it doesn't say that you have to screen them for all these infections and make sure they haven't got them. It says that the kitten must or the puppy mustn't have diarrhoea. And that's because if the faeces.
Solid and providing gloves worn litter box is handled well, then the likelihood of shedding any of these infectious agents becomes vastly less. It's when you've got diarrhoea that the problem really occurs, particularly where you've got faecal incontinence. So, let's now think about our our individual cats presented to us.
What are we gonna do? What's our decision making? Got a great picture up here with a good reason for this cat's diarrhoea.
This little kitten has eaten the sewing thread and it's tied under her tongue going all the way down to her gut, so she's vomiting and got diarrhoea. Clearly, she needs surgery. So look at the history.
How's this kitten? Different things. If this kitten is well protected against panachopenia virus, then that is unlikely.
It doesn't mean it won't ever happen. It's a very good vaccine. But if you're dealing with a big multi household, that's got a lot of environmental contamination, then this infection can break through.
You want to know the worming history. Has there been, have they been wormed and what with? Has there been a diet change?
And then environmental factors, you know, what is the hygiene like? You know, what are the animals fed, particularly by way of raw food or food where we're not sure quite where it's from. What is the risk of infectious agents?
Do they live with older animals that might be ill? And in multi-cats, multi-animal affected households, it is usually either infectious or environmental, and by environmental that's usually drugs or or toxins, so you wanna know. Then you want a physical exam, and you were looking particularly for things that would indicate that this kitten needs to be hospitalised.
What's really important is kittens get sick fast. So what would be, for example, a week in an adult cat's life, a week of progressive illness, a kitten might do that in a day. What would be a day in an adult cat, a kitten might do in an hour.
So they decompensate fast. Remember, they've got a higher percentage water in their body, so they dehydrate very fast. So you were looking for things like, increased lymph nodes.
Is the kitten already dehydrated? Tachycardia, or really bad news, bradycardia. Bradycardia and hypothermia is bad news.
All right? Really bad news. And then is there abdominal pain, potentially a mass.
All of these say this kitten needs in and we need to work it out. If you've got some mild diarrhoea and a single kitten, you might want to try asymptomatic, therapy. What you will find is there is a lot of debate to starve or not to starve.
I would never starve more than a day, and that would be a 6 month old, kitten. But even then, you know what, I'm starving less and less and less, the more we know about cat intestines, for that matter, dog intestines, we know that the intestines can only repair if they're fed. So it is actually much, much better to not starve, I 0 starve.
But what you switch to are very small, very easily digested meals. A single protein source, which is a meat protein source, it's been cooked where you can use a hydrolyzed diet. You do not need a lot of carb, and if you're adding, if it's a diet with carbohydrates, ideally a single carbohydrate source too.
A lot of people suggest being gluten free. So good quality diet is what you're really looking for. Nothing with milk, which can make things a whole lot worse.
And if they haven't been properly wormed, let's get them wormed. As I say, it's more severe disease when it's become chronic, which is 3 weeks plus, it's a classic fighter, but yeah, just go by the kitten or if there are more than 1 kittens affected. So what are we gonna then do?
Well, starting point is, let's look at the poo. The poo has gone wrong. Let's look at the poo.
And we want fresh poo, and I'm gonna labour it a little bit because fresh poo is really important. There is no point scraping something that's desiccated off the carpet or scraping something off the side of the litter box that's got a whole little litter in it. You're never gonna find the causes doing that.
So you do want fresh faeces. We're going to talk about smears, and we're gonna be talking about other ways to to look for parasites. I'm not gonna go into this in detail because I know a lot of it don't do in your practise, but there are one or two things I really think it helps if you do.
Then there's culture for potentially enter apathogenic bacteria, and more and more we have the PCR panels, but they are not without risk of interpretation. If you're sick, then we want to do haematology biochemistry, so we're looking for things like anaemia or panicopenia. We're looking for things that might indicate FIP.
So maybe low lymphocytes again, maybe high, globulins, low albumin. You might want to do serology depending on the kitten's background, depending what things you're thinking about. B12 folate, PLItLite, these tend to be in more chronic cases.
Radiography can be very useful, but in a little kitten, they tend to have very little fat. So getting any contrast in the abdomen is pretty tricky. Ultrasound is gonna be a better way to go, but you might need a standoff.
It's very little kitten. And a therapeutic trial. I've put this in red because I think this is really important.
Awful lot of kittens, they've got diarrhoea because of diet. So you know what, let's address diet. Let's do that, get them onto a very protein restricted, highly digestible diet.
If they haven't been wormed, an anti-almanic trial, even if you haven't proven that they've got worms, let's just roll it out. What I really don't want people jumping into antibiotic trials because as I say, this can trash the microbiome and leave the kitten with such severe dysbiosis that it's then got diarrhoea for the rest of its life. And you're not gonna be thinking about corticosteroids unless you're dealing with inflammatory bowel disease, and that's really gonna be a cap.
Not really talking about that here. Endoscopy can be pretty tricky with kittens unless you've got a very small endoscope. So expla, if you have got a kitten that's that sick.
If you are doing anaesthetizing kitten and doing an ex-lap, please take some biopsies. Don't just go in and and let the let the vapours out. Let's take some biopsies to find out what's happening.
So, Let's take it back for a minute and think a bit more about infection. And this is a big bind, and that is so many of our kittens are gonna have asymptomatic carriage. Or they're gonna have disease caused by these infections.
So how on earth do we decide? And you have to put the clinical signs together. You have to find out what infections are there, and then it is a case of trying to decide what do I think is most important in this case.
So, you are much more likely to find infections, young cats, group housed, stressed cats, those that are fed raw meat. And those that already had GI disease for some other reason. But look at some of these numbers, these from a number of studies, it would be too confusing.
All of the references down, but this is carriage in normal cats. Can pay up to 60% salmonella actually, to be honest, that was kittens in a rescue centre that were up to 18%. Gia, one study, 11%, some even higher.
Cryptosporidium, 12%. And Clostridiumdifia. I'm not sure how anyone's pronounces it.
We will pronounce it differently, about 20% was preferringgens. Oh, it's up to 60%, but if you're looking for the the toxin, then it's much lower. But this shows you that this little kitten could have any of these in his faeces.
It doesn't mean that's the cause of his, his disease. It could be dire, so you've got to think of both. I want to share the results of this study with you.
I've already mentioned it. It's, it's the IDEX study. This is a study I did with one of my residents, a few years ago now.
We had over 1000 diarrhoea samples. You can see coronavirus in nearly 60% of them. the Clostridium perfringences, and this is the gene for the toxin.
Doesn't mean that it's actually producing toxin, but it means they've got the gene, nearly 60%. Well as we've got 20% with alva viruses, Giardia, Trochichomonas, and cryptosporidium. So you can see all of these cats had so many.
How do you decide what's important? What I do think is if they've got salmonella, we have to consider it because it is such an important potential zooos. And Toxo, of course, these are going to be the kittens that are shedding toxo, so they've hunted for the first time.
This really is the cause of their diarrhoea. And I think it's important to see, on average, well, by far, most of the kittens had at least 2 pathogens, some 3, some 4, some 5, something like, some cats were so greedy, they had 8 different pathogens. Now that's kind of crazy, isn't it?
So just looking at one. Doesn't and treating one doesn't mean you're gonna get rid of the others. And how do we know it could be one of the rarer ones that's actually causing the diarrhoea.
I know you're getting exasperated with me. But the, the outcome of this study, that's where it was published, what we found was that there was moderate to high prevalence in most things other than toxo and salmonella. Here cats had an increased risk of Giardia, trying to cremois and not surprisingly, coronavirus.
And the kittens were more likely to have coronavirus, paver virus, Giardia, tritre, and crypto. Quite often, all of them. And yet their diarrhoea could be caused by getting something with milk in it.
Multiple carriage is incredibly common, particularly in pedigrees and young cats, and Tritrix, which is, bugs that I spend far too much time giving advice about. It is really a party animal. It really occurs on its own.
So when you see it, And when you treat it, it doesn't get better, you've got to then look for what else the cat's got Corona, Clostridia, Giardia, crypto. All right. I hope that kind of sets it quite well.
When we're thinking about trying to work out whether or not an infectious agent is causing the problem, it could be to do with the number of organisms, that's often really important, but you can have virulence factors. And the age is really important. Baby kittens are much more likely to get sick.
Other things can have an effect as well, as you can see. Then you've got the environmental pressure and classically, we're gonna be talking about the, the stress of multiple housing, rescue, diet changes. I should probably have put that in red, but we definitely want to worry about antibiotics as well.
And when we decide that we're gonna look for infectious agents. As I've already said, so many normal cats have got them. So, how do you know if they're there, they're important.
But then the ones that are actually causing the problem, they may be excreted intermittently, so we may miss them. Some bacteria, particularly Clostridia, can be quite difficult to grow. And then others can be really difficult to to detect.
So we can miss the important ones, but then find everything else. And then sometimes you get back a faecal report that says the cat's got everything, and then the cat's better by then by the time you phone the owner and you, what do I do with this? I wanted to say a little bit about samples.
They must be fresh, particularly if you're looking at swabs or smears, they, the fresher they are, the better. Fresh from that squeeze cats bottom onto a glass slide, it's not quite, but you don't want dried up poo. We also do like flushes.
So this is where, particularly if we're suspecting trichomonas, we will put a soft catheter with with lube, and we'll put it up the little kitten's bottom. We put a little bit of EA, local anaesthetic on his bottom first, and then we push it up, so it'll be to the level of the transverse colon. Flushing little saline, squish the kitten's tummy, and then squishes, squish a little bit and suck it back out again.
That is much more likely to give you tri tricks and looking at actually faecal material. And also for looking for tritre jelly, you know, that the, I kind of talk about poop marmalade, that stuff that comes out, that stuff's much better for looking because they they're swimming, organisms, little protozo that swim, and they like to be in that that jelly. So the quality and quantity is important.
Make sure you send enough for analysis. Handle them correctly. Do they need trans transport media?
If you're looking for some cultures, you might do, and you say, don't leave cat litter in it. This stuff is actually completely good at killing off a lot of different pathogens. Make sure you know what the lab is testing for.
Is it testing for what you think this cat might have? And repeat sampling. The classic for me was 3 cats that Nick Bomer was treating, Beyonce and her friends.
They were 3, Asian cats, and they had large bowel diarrhoea. Everything was screaming touna's foetus. And he tested them 3 times and they were negative.
And he came to me and said, Look, Daniel, what am I missing? And I went, sounds like tri tricks to me. Do it again.
Send it to to Langford this time. The PCR is just a little bit more sensitive than the IDEX or the capital. Yeah, we got it on the 4th test.
So, repeat, if you're not, if the cat is not getting better. And here I really wanted to highlight faecal smears. So we do this a lot.
This will be fresh poop and say that poop marmalade, as I would say, and just add a little saline, warm it up in your hands and put it under a glass, and, cover slip, and I'll show you what these little guys look look like. And you can see them swimming. You can make a diagnosis so quickly.
It's not sensitive, but it is very specific. What I also do do, and you can see Gard as well, they, they swim differently, so you can tell them apart. If I've got a large bowel diarrhoea, particularly where there's blood in it, then I will do a a rectal swab.
So a little swab, moisten it just into the, the little cats through the anus into the large bowel and just gently on the wall and then put that onto a glass slide and stain it like this quick, you're looking for lots of neutrophils. That's likely to point you towards something like salmonella or Clostridium. That can be quite helpful.
Make sure that the, the lab you're sending it to is looking for all the infections that you want to because as you can see from these other comments, if you're not doing all the steps right, you can miss it. I'm sure most of you aren't doing these steps in, in-house anymore. There are some in-house sap type tests, so the classic would be the parvovirus one.
The parvovirus one, the canine parvo works perfectly on cat parvo, so please don't forget to do that one. And then more and more, I think we all do the PCR panels. But just to reiterate, yep, they're reliable, they're specific, and they're sensitive, pretty costly.
But just because the infections are there does not mean that they are the cause of the diarrhoea. The coronavirus rarely causes, diarrhoea. Par the virus, that's gonna be a dying kitten type diarrhoea, not just a mild diarrhoea.
Sorry, let's take a bit of water. Ostridium can be anything from Asymptomatic to really severe, and the same with these guys. So, you know, you do have to look at the case and and take it from there.
So I promised you cases, cases it is that Tully, 4 week old, little Bengal. He's one of 24 weeks old. That's the important thing.
He's got sticky yellow diarrhoea. He's well in himself, as you can see, but he is dehydrated. And remember, kittens lose fluid fast.
So cause of diarrhoea in this kitten. What do you think? Well, Remember, we've got the major ones diet and infection.
If he suckled well, this is him taking on antibody and colostrum, that will slowly fall, and if he suckled well, then he should be protected from mom's colostrum against the infections that are in her environment. And hopefully, he is now in her environment as well. She hasn't moved from the environment that she made those antibodies in before she had him as as gave birth to him.
So it's unlikely he's gonna have an infectious cause if he suckled well. But if it doesn't stop a while, then that window gets a lot bigger and it could be infectious. Non-infectious causes.
Mastitis in the dam is certainly potential, not common. Supplemental feeding, that's by far the more common. If mom isn't good at feeding them all and they're getting a bit of bottle extra, it's easy to get those bottles infected or to overfeed them.
But weaning is really important. Getting too cold is really important too, because if they get cold, remember, kittens don't, it's this little kittens, they don't have brown fat, they can't thermoregulate, their livers aren't very efficient, so they can't make heat from that either. So for so many reasons, little tiny kittens cannot keep warm very well.
They will stop suckling, which means they're not taking in milk. The gut stops working, their immune system stops functioning, and they get hideous diarrhoea. For hygiene plays into this, the bug numbers will increase, so we've got to keep kittens in a hygienic hygienic situation.
So often I see kittens weaned onto a milk-based product. If it's kitten milk, which is actually not kitten milk, obviously don't, don't milk cats, but at least it's a, a, a formulation, a formula that is OK for cats, but I'll see people putting cow's milk and, and they are so often get get diarrhoea. And then in the post weaning, you've got this window, and there's a number of different things that can increase the risk of kitten getting diarrhoea from an infectious cause.
I've already mentioned quite a few of them. What I really want to comment on is a congenital deficiency of immunoglobulins. There is a test available for this now at CTDS that's Carmichael the CTD I think it might be Carmichael Torrent diagnostic Services.
I'm dyslexic, so I've muddled them up. Some variation of those, please. And they run from serum IgG, IGA and IGM.
And I'm now being able to identify more and more of the kittens that I'm seeing with recurrent GI problems, recurrent GI infections, recurrent respiratory infections, and we're being able to confirm that they do have congenital problems. I've certainly seen this a lot more frequently in rag doll cats. And at least you've got a prognosis if you can't actually make them a whole lot better.
And we've mentioned here. And this is a face only a mother could love. So, infections in kittens, they are usually mixed.
It may well be secondary to viral infections, and GI and respiratory are the most common. The infections usually come from mum or the environment, obviously. So what do we need to do?
We need to detect them and treat them early. They need supportive care, where we can find a specific cause, then clearly we've got to treat that. Salvation, I've already said, really, most of us now are down to the zero.
What you need are small, frequent at room temperature, not cold, eat meals easily digestible. Kitten food is a cheaper option. If you want, if you don't want to go for one of the commercial diets, which I do prefer, then a kicked cooked chicken is, is fine.
It's a bit much for a little baby kitten though, that's gonna be an older kitten. hydrolyzed diets are another way to go. As I mentioned before, I, a lot of people suggest gluten-free and, you've got additional omega 3s, etc.
Any kitten that's got severe dehydration, and when they do, or even mild dehydration, then you're gonna initially think about oral rehydration, but remember, once a kitten has got cold, Its gut stops working. So if you've got a hypothermic kitten, there is no point putting water, oral rehydration solution and definitely not food into this cat's gut, because it simply won't be absorbed. It's just gonna sit there.
So if this kitten is cold, you are going to have to give systemic fluids. And I really like mic soon as long as they're warm, then microenteral nutrition. This is even if you can't keep, they can't keep very much down just get something into their guts because that will reduce the risk of bacterial translocation.
I do like things that have got glutamine in them that does seem to help. And what about antibiotics? I guess, you've already got the idea.
I'm not keen on them. They can cause severe and permanent damage to the microbiota. Not only that, with kittens, they are, they absorb drugs much more readily than older cats.
They've got much less albumin, so you reduce protein binding, and they can get across the blood brain barrier much quicker. So they're much more likely to cause toxicity. Definitely don't want to be using aminoglycosides or tetracyclines.
All the kittens, if you must use a tetracycline, well, not tetracycline, you would use doxycycline. And there is a monohydrate formulation, which is a chicken flavoured paste, which is the safest. Moderate risk, trimethoprine sulphur, but you know what, you never get that into a cat's a disaster.
Macrolides, we do tend to go to Tylazin for GI cases where we know we've got a GI infection. Metronidazole, again, for GI infections, but please be careful if the the these cats can get toxic side effects pretty easily. And quinones, you don't want to go to those unless you really have to.
The cartilage damage is less than in than in dogs, but it can still happen. So the antibiotics for systemic causes causing diarrhoea, we're gonna be going to penicillins . Encephalosporins, and we're really gonna want to go subque because that's not going to trash the bowel and the microbiota anywhere near as badly as if we give it pers.
But clearly if we're trying to deal with an infection, actually in the cat's, how, for example, using metronidazole for Garda, then that does need to go for us. Absorbent, you'll find those in quite a few of the combinations. OK, prebiotics that promotes the growth of beneficial bacteria.
I like those. Probiotics, I like those too. We're gonna mention those.
I don't use any of the motility modifiers. These are, are not safe to use in baby kittens. But steroids, we're not gonna be going there.
Hello. Diarrhoea associated with weaning. He's on his IV fluids, as a gratuitous butt shot.
We didn't starve him. We put him onto cat milk formula 50/50 initially, and then kitten food. What about probiotics then?
Do I like them? What's, what's the evidence base? Alaplex is is just B12.
I'm not sure quite where I put that there. I just mentioning that Protein is a company that's really getting into this nicely. Most of the work was always done by Purina with the 40 flora, which is forcoccus arum.
This company also uses Eococcus viarum. And you've got different combinations. This one I really like because you've got probiotics, prebiotics, and B12 because it's now been shown that giving an enterococcus rearum can drop the B12.
So you either you give this one plus B12 or have one or that one plus B12, then, or that one's got it all, which is great. A live bacteria. They are supposed to only temporarily repopulate the bowel, but sometimes they can hang around for a bit longer.
These are the classic bacteria that we use, they tend to produce like a positive. Most of the ones that have been trialled only have one different bacteria in them, usually enterococcus arum, but there's two new kids on the block. One is called Sivvo and one is SL3 hash.
These have multiplex ones. There's some good work in dogs looking very positive, but none in cats yet. They often have prebiotics like fructogalic saccharides, which help these guys stay alive and happy.
Mechanism of action, they reduce the pH with that acid, and that reduces pathogenic bacteria. They reduce the adhesion to Clostridium camping and you can see the other potential. So classically, there's certainly good safety studies, and where it's most recommended data is much better in cats oddly enough, other than dogs, dietary changes, times of stress, rescue situations, during or after antibiotic use, these kind of cases are good cases.
And here are some studies for you, reduced, time to recovery for acute GI in dogs. Here we've got a reduction of diarrhoea in, in kittens, decent number, it's rescue colony, and it's double blow placebo controlled study. And in a 4 week study, then diarrhoea lasting 2 days or more was 7% of the kittens that didn't weren't on the treatment and nearly 21% all the way around.
21% of the, the kittens, sorry, yes, that weren't on treatment and only 7% I get there, that are on the 40th floor, reducing the number of Clostridium, reducing chronic diarrhoea. So here we've got some studies. So some good studies.
Here you can see that that's SF 68 is the bacteria. You can see that in the control cats they don't have much of, so this is the number of of Clostridium preferrings, the cats are on the treatment, don't have much Clostridium. The others have lots, which is bad, whereas you get an increase in bifidobacter and Lactobacili, which are good.
If you look at this study again, we've got kittens treated with this, how much diarrhoea they've had. And you can see the kittens that were treated had a lot less diarrhoea through the 5.5 months in the rescue centre.
So little Tully got better on probiotics. Now we have Ben and Jerry. Oddly enough, Bengals, again, I see a lot of squinty Bengals, and I've had a Bengal myself, and she was squitty through most of her life.
So these are 216 week olds. They're 2 of 5, and they have come from the breed of 3 weeks ago. So there is a point of stress 3 weeks ago.
Ben is pretty well grown, looks pretty good. Jerry is not so bonny. They have got diarrhoea.
It's large bowel and blood and mucus. So I'm gonna be thinking tritrex, Gadic possibly, isos possibly diet risk. Yeah, definitely.
So, what am I thinking? Yeah, Corona, because we never know where to put it. But yeah, I'm gonna be thinking all of these guys and I'm gonna put salmonella in there too, because it's important.
Right. Well, If being vaccinated. Good, that takes out part of the virus.
If being wormed, there has been a diet change and it's multiple cats in one household, so we are thinking those two, so infection or diet most likely. There was no real dehydration or abdominal masses, so we didn't, we felt, let's just look for the faeces, but let's start with a sy with symptomatic treatment. They did get a little starved, but in retrospect, I probably wouldn't do that now.
I would have simply got them straight onto an easily digestible. And they went on to cook and they did get probiotics, at which point then is now fully better. Harry still has large bowel diarrhoea.
So at this point, yeah, let's look at his poop. So, we look at his pope and our little Gerry has got Giardia and Azospor. And this is not uncommon at all.
We often see this. So our options, we could treat with fem but so for Giardia, we've got fembendazole or metronidazole. There is a question about efficacy of febendazole in cats for Giardia.
It seems to work better in dogs, but we need more studies. But it's a lot safer. So I'm gonna start with this.
So you start with the safest drug. So I would be thinking of febendazole to treat the Giardia, my metronidazole is my backup. To treat my, Izos, I can't get myself into its system isospin.
And depending where you are in the world, you've got tontai or Panazol, which sold as Bacos stuff for chickens, but we always have some in the in the clinic. Lindamycin you can use as well or tramethoprine sulphur. That in kittens it makes them foam in the mouth and makes them look rabid and be miserable, and this makes them feel queasy, so.
You know, I'm gonna be thinking what to do. You know, at this point, I went with Vanbendazole. So, Still positive.
What am I gonna do now? Well, at this point, OK, I switched to, I'm still trying to treat my GRD yet, so I've gone metronidazole. If you should really go for a higher dose twice a day, does make me feel pretty sick.
And at this point, I treated with the bay cocks as well. So I've now treated Jerry for his Giardia and his ospor. Is he gonna get better?
No. No, at this point, he's now negative for cystizosin Giardia, yay, but he's still got diarrhoea. So what am I gonna do now?
Now, I do a PCR panel. And actually, at this point, I was certain this was trit. So I just did the PCR at Langford, which is a, it's a quantitative PCR is a little bit more sensitive than the IDEX or the capital diagnostics.
Those two are equal. These. I wanted to say a little bit about this because it does seem to cause some problems.
Host specificity, we certainly know, mainly in cats, you can get into dogs, seeing more and more in dogs, occasionally into people, so think about hygiene. We see it in multi households and rescue centres, particularly in pedigrees, particularly Bengal and Siamese. Well when you get it in a Maine Coon, it's all that his trousers, it's really not a lot of fun.
They are usually babies, but they get sick when they first get infected. So you can see it in a 13 year old, for example, if a little kitten with diarrhoea with Tritrex has just moved into that household, and the prevalence is up to about 30% worldwide. Anything from asymptomatic to very large bowel.
And so you often have, a lot of blood and jelly, you know, this, large bowel marmalade, as I call it. Can be absolutely reeking, and they really can have awful faecal incontinence and anal in inflammation. But other than that, they are usually, but not always well.
We do see occasional ones sick, that is usually where they've got something else as well, quite often FIP. That's because they're going to be young pedigree cats, so they're at risk of FIP as well. So just because you've got the large bowel signs, don't presume it's all tri tricks if you got it.
Diarrhoea can last for years and wax and wane, and yeah, it can spontaneously resolve if you're willing to wait for 3 years or more. I've had cats to keep it longer than that. Faecal incontinence, I don't think so.
Some suggestion in other species for reproductive disease, but that hasn't been born out with, with cats. You can do a fresh faecal smear, and I think this is important, fresh poop, and a number of kittens I've had referred to me because they've had large bowel diarrhoea, and they've been tested for it repeatedly. And it just happens the day that I catch them, and the kitten is just doing a drip of, you know, jelly, and I just catch that little bit of jelly and look at it straight onto a glass slide, drip of saline straight onto the microscope.
And what you see is this. What Winton. I don't want that again.
Oh Forgot this volume on it. We, we call these poop sperm. I'll talk over the top.
So they, they, they swim in pretty straight lines, and it's very forceful forward motion. This is unlike the pattern you get in Giardia, which are much more like this. So let's get back to my point.
So you can get a diagnosis purely from just getting that fresh faeces. If you take the sample and then send it in the post, you can often, you, you can lose it. All right.
So I really do recommend let's look at fresh, samples. I talk. You to a colonic flush.
The other thing we do is where you've really got a good indication, this looks like Trire. I will give them lactulose for us for a few days until I make the diarrhoea worse, because I know I'm more likely to get the the trooides swimming, when I do that. Nobody really does the culture.
Most people do PCR. Remember, it's always said to be 97% sensitive, but it's very specific, but it does miss them. All right, so a lot of them are intermittently shared.
So 24 hours, no no litter box in there and keep looking for it. Treatment, sometimes just increasing fibre, and particularly probiotics, that's a really good combination. But by way of drugs, it's really tazole really doesn't work.
It's got to be renidazole. Baby kittens, I'm gonna go with 10 mg per kilo perros once a day for 2 weeks. Bigger, stronger kittens, I'll go up to 30.
I'm not sure I'm gonna be going, OK, you know, the middle size kitten, you know, 3 months old, 4 months old. I'm gonna go 20 makes per kg because you know what, I can do it again if I need to. While they start that 2 weeks of Renidazole, they are going to have 4 weeks of a probiotic, and we worked with protection on this study, and we showed that here you can see that the group A is placebo.
That's the blue group and group B is the procoolin, and you can see there are a lot fewer relapses when we gave them a month of this starting at the same time. And the Renidazole doesn't kill off the enterococcus, which is obviously really important. However, you can see neurological signs.
If you do stop the drug. It is a teratogen, so no pregnant queens must be treated. If there is anyone human pregnant in the household, then I really suggest these cats are kept in your clinic to be treated.
And the question is then, do we treat Ben too? Because he's now well, but he's very likely to be carrying, if not shedding, tri tricks. Problem is this rannidazole isn't a licenced drug, it's a special.
And, you know, it's a pure chemical. So, the owners have to be aware of that. They have to be aware of the potential risks, and they would need to sign to say that you had spoken to them.
If you see neurological signs, can you let me know? I'm trying to gather more information about that. And our last case quickly is Emma.
She's kind of the other end of the, the, the, the pattern. She's 8 weeks old, little rescue cat, one of 4 kittens that were born, one has just died. 2 developed vomiting and diarrhoea and died.
And then Emma comes to see me. She's got severe watery bloodstained diarrhoea. She is depressed.
She is dehydrated. She is not a happy girl. Her tummy is painful.
So the more likely causes for her, I'm thinking ar the virus. Remember that can be canine, acute, leukaemia virus, potentially even FIV could do it. It would be unusual for corona to be quite this bad, or for campy to be quite this bad, really.
Salmonella. Yeah, definitely. Giardium, potentially, but not likely.
These guys probably not, well, Let's see what we've got. Blood, she's anaemic. She's only 8 weeks old, so that's not so bad, but she's panleukopenic.
She is a panicopenic kitten, and what causes panleukopenia and diarrhoea? Feline panlekopenia virus, but also canine panleukopenia virus, also salmonella, also these two, particularly FIV and kitten toxoplasmosis. All right?
So there is more there on that list than you might think. So how do you try to confirm? Well, for papa virus, Clinical findings, yeah, but use just one of this snap in-house diagnostics.
They're very efficient. You could do serology, but she's just about to get vaccinated and you don't want to go to PM because that means you've lost. You don't want to lose.
FELV and FIV you can tell that pretty quickly by doing the snap in-house. Toxic osmosis, that's gonna be a tough one. At this point, if she's just a baby, you could look for rising antibody teeters, the rarest of the list.
Salmonella, you should get on culture or PCR. And these other guys, usually you're gonna find on, on PCR or otherwise. But where you really see the white cells coming down, then as I said here, you're really putting these guys at the top of the list.
And I unfortunately, I do see this frequently enough and she is a part of a cat. How are you gonna treat her, supportive care. She was so dehydrated, we couldn't get an IV line, so I've put the needle directly into her femur, just do it like that.
You can just push it through. The bones are so soft at this point and just using that was a standard green needle. Broad spectrum antibiotics are required at this point because they end up having no white blood cells and they are translocating all the gut bacteria.
So, a penicillin or cephalosporin would be appropriate. She is painful and she is vomiting, so Murropotin is gonna be a good visceral analgesic and stop her vomiting. Let's protect the gut if we can, and with HD blockers.
Keep her warm, keep her clean. She is shedding loads of part virus. She is seriously at risk of infecting everybody else who hasn't been vaccinated.
So you really need to think about all the bedding she contaminates. Microenteral feeding has been shown to really help keep these guys alive. That's Tamiflu, if you can get hold of it.
And then last but not least. Apologies, I know some of you will have had to have have had it on, but I know you can watch the last bit later. You may need a blood transfusion if she loses too much blood in her faeces and some of them can.
She's probably not been vaccinated, in which case you can take serum or plasma from a vaccinated cat and give that to this little girl, you can give it sub Q. You can always give her some, which can help. You use colony of granularite colony stimulating factor, but it's really expensive.
But I do recommend verbigen omega. All right, this is the recombinant feline interferon omega, and this is a study done in dogs with polo virus. They're given high dose.
This dose is antiviral, right? It is it's immunosuppressive, so you need to keep them well covered with antibiotics. This is when you get to the kittens at this end, you do need your antibiotics.
What we don't want to see is antibiotics in the kittens, which are not really systemically ill. So it's high dose, it's IV, it's for 3 days, and what I always say to the owners is, give me 3 days. They will either be dead or getting better by then.
And in this study, dogs, decent number, over a 9 day period, there was a 4-fold more loss, 4 times as many cats of this case dogs died, compared to the ones that were treated with the interferon omega. So I do recommend it if they can afford it. But there are side effects, you'd expect there to be nothing comes for free.
So you do need to get these cats covered with antibiotics. My last thought I'm gonna leave you with and little Emma did fine. She was left always with a delicate tummy, and a lot of these cats are.
And what we're now doing for some cats and some dogs as well, where we have completely resistant diarrhoea. We can't get it resolved with anything else, so they're like really the worst inflammatory bowel diseases. We're doing faecal transfusions, which in the phrase, this is so phrase, a Transfusion, which is great, and that is something to consider in all the kittens, if they've got they've been left with particularly power the virus associated.
Vila are always going to be really short. We may not be able to, to improve the microbiota, but at least we could try. So I hope there was some interesting cases, some interesting facts for you.
Getting diarrhoea can be very, very frustrating, but it can also be incredibly rewarding. So I hope that was OK. Thank you as always to webinar vet for running fabulous, fabulous webinars and to Mile for making this one available to everybody.
Thank you. Thank you so much, Danielle. Another amazing webinar as always, some comments coming in saying great webinar, really informative, and I do have to agree on that, aspect.
For anyone who is, watching and there's there's perhaps something you missed or you want to catch again, the webinar will be uploaded to our website, within the next few days, so you'll be able to go through all of that again. All of the information will be available to you. We'll send an email out to let you know when that's, available.
We do have a few questions coming in, so let's start. A good question here from from Bev. Does the feline vaccine protect against protect against canine power though?
A good question. People haven't done the study in that direction. Certainly, yes, well, I see what you mean.
If you mean, does the, does vaccinating a kitten with feline arbovirus, does it protect against canine arbovirus? Yes, it does. Absolutely.
So it's important that kittens, particularly if they are going to be living with, you know, in a rescue centre, they need to have that vaccine because it will protect them against the cat strains and the dog strains. Excellent, perfect, thank you very much, and Devils, this is another great webinar. I have a question here from Mark, who said, there's been some question of increasing antibacterial resistance of healthy bacteria when probiotics are used simultaneously with antibiotics rather than than afterwards.
Do you have any thoughts on that? I think it's a really good, question. I was gonna say, thank you, Bev.
So, the only time I use probiotics and antibiotics together is with Trichomonas foetus. Well, other than that, I'm gonna use my, my probiotics usually with prebiotics, sorry, with prebiotics as well after. I've given my antibiotics because what we don't know is, as you say, that the, are the probiotics going to just be killed off by the antibiotics?
Are you gonna, as you say, select for resistant strains. We did work when we worked with Protein to make sure that Renidazole didn't kill off the enterococcus fiarum. We didn't do the study where we gave Protexin after the Reiddazole.
We did do it at the same time. I have subsequently tried that on a few cats, and it's not been as successful as giving it at the same time. So, certainly with Tritrex, I'm gonna use Eococcus fica, preferably to say that we did the study with the procoalin, so I I can only really speak for that.
But I would expect the other products with enterococcus arum to VM is the other way of saying it, to behave in a similar way. But yeah, he's absolutely right. You do have to consider whether you are selecting for resistant bacteria if you give them at the same time, antibiotics and probiotics.
Good question. Very good question. Excellent thank you very much.
I hope that helps Mark. I'm sure it will have done. Question here talking about Renaidazole, how do you dose?
Is it suspension, reformulation? I did the initial work with Nova Labs NOVA, and we initially imported chicken powder, powder just to treat chickens with, no, a pigeon prep, but it was a 10% powder. Please don't use that because the powder, the actual drug is much lighter than the rest.
To the because it's a 10% prep, there's 90% of other powder, which meant if you scooped from the top of the 25 gallon drum, you got nothing but reiddazole and the cat dies. Well, we didn't lose any, but that we had horrible neurological signs. If you scoop from the bottom, there's no effect.
So now we're using a 100% pure chemical from Sigma Labs, and they nova started, they put it into capsules. It is incredibly bitter. It does have to be recapsulated.
If, and I actually will go to the point of polishing the little capsules before I give them to the cats because there's any powder left on them, they won't take it. Since then, Summit has come online and Summit is also doing capsules and Bova Labs, which is BOVA. That's our third reformulation company.
It, as yet, I, I don't think it's doing, . Renidazole, but I'm, I'm kinda, I throw the gauntlet out to any of them to try and make this up into a paste. I think it will always be too bitter, but if anyone can do it, it would be overlaps.
But at the moment it is capsules. Wonderful, thank you very much, and I know Bova are looking for feedback and that's thoughts of what they would like to see more of, so any comments that like that would be very useful. It's a couple of interesting questions here actually.
So, Emily is saying, Stan Marks said at London Vet Show, if there was blood in faeces, then he would always cover with antibiotics from the beginning. What are your thoughts on that? Oh, I love Stan.
He's a great mate, but I think he's talking rubbish. No, it's that there have since been, and I don't know whether there was a cat or a dog talk, but there have since been certainly, there's a very interesting paper that came out recently, with hemorrhagic gastroenteritis in dogs, where they're pouring blood out of their bottoms, and use of antibiotics didn't improve their outcome. It's pretty scary to not step in when you're pouring blood.
And certainly, if I'm dealing with some, you know, a part of the virus type situation where I've got a fever, I've got dehydration, and I've got blood out of the in the faeces, then yeah, I am going to cover those. But where I've just got tritrex type blood, yes, you can have quite a bit of red blood, but they're still bound. Around the consult room, I am not going to be trashing those cats microbiota.
So, I want to know that I need to treat, otherwise healthy cats. So Stan and I can choose to disagree on that. And certainly, he, you may have heard him speak before that paper on hemorrhagic gastroenteritis came out, because that has changed a lot of people's thinking.
But all of these questions are brilliant, so thank you guys. I didn't thank you lovely delegates, which I should have done, because otherwise I'm just sitting here talking to myself. What makes it is knowing I'm talking to you and getting really cool questions afterwards that make me think.
So thank you. Have you got some more for me? I have indeed, yes, thank you very much, everyone.
The interaction is very much encouraged. Great comment here from Tara, he says, thanks so much, very timely, dealing with a little kitten with diarrhoea at the moment, so hopefully this is, has helped with, with treatment there and diagnosis. Hope so, Tara.
Question here from Phil, you mentioned intraosseous fluids, into which part of the femur would you suggest? I just go into the, the head of the femur exactly the same way as you would do a bone marrow aspirate, or for those of you who do orthopaedics, I was never much orthopaedics. I tried pinning a femur once and I ended up pinning the cat to the table, which was, as my residents would say, suboptimal.
But no, just exactly as though you were doing a bone marrow aspirate into the the. Of the femur. So, literally just behind the, the greater cancer, yeah, and straight down.
And it's really easy to do. I've done it with semi-collapsed kittens, literally, you shave them, prep them. I amler them first, let it just soak in a bit, and you can literally take a standard, you know, green needle and push through, and it will go through.
Yeah. Very easy to do. The hard part is finding a way to secure it.
I tend to find that I have to sew them in because trying to use tapes, they just, they slide out. Excellent, thank you very much and Phil said really useful tip there, so I'm hoping that has has helped him. Tara said that it has helped, so that's always good feedback.
Thanks, Tara. I have a question here for me, just going back to the, the parvo. Did you say that canine parvo snap test can detect the feline panleukopenia virus?
100%, yes. So that is good to know. We just use the doggy one, the same as the Your, 4DX for your tick borns, which of course is now a 6DX or they still call it 4DX, that works on cats as well.
So, obviously not for Pava virus, but for diagnosing other stuff. I'm quite happy to jump on to doggy diagnostics when we've got them, if they work. Yeah, the, the doggy pavavirus works great for cats.
Fantastic. Thank you very much. I have a question actually you mentioned, a paper regarding, blood and antibiotics.
So, do you know, do you have the details of that, paper? I can, I, I should know it off the top of my head if I was a, a, a better clinician, if certainly my guys who do more focus more on GI, they could tell you it and they'd go, oh, Danielle, how can you not remember? What I would do is You guys, I decided this morning that I figured you could probably use some notes on this.
So I'm gonna write you some notes over the weekend and I will add that paper reference in for you. All right? I've put a reference in for the, for the guidelines for the, AC ACVIM guidelines in there as well, but I will add that extra one for you.
All right. So I'll do that for you. Wonderful, thank you very much.
And yes, send that over to us, Danielle, we'll let everyone know when the recordings available as well, and everything into the, the same email and we'll let everyone know. So that's very helpful. And Emily's also said, thank you so much, Danielle, you're fab.
Hopefully we'll see you at the London Bet Show this year. Again, I'm, I'm not going again. My travelling is being disabled is, is that much harder.
But I do intend to try and get to, ISFM next year. It's in near Dubrovnik. It's on infectious diseases, and, you know me, I love my infectious diseases.
So, my PhD students have all decided I've got to go. So they're, they're gonna look after me and take me across that. So I look forward to seeing everybody there.
As if we are already needed an excuse to go to Dubrovnik, now we have Danielle there as well, so what better encouragement. Thank you. I have a question here from Wang Qing, who says, when giving fluids, does the fluid need to be warmed beforehand?
Really good question. I do warm it. I'll at least it's not the most effective way, but I'll put the drip line, around hot hands if I haven't got one of the special warmers.
The hardest thing about drip. Keeping drips into interosseous is they clot pretty quickly. Remember, it's going straight into bone marrow.
So I do tend to find they need little he flushes a little bit more, but just be very careful on, on the amount. But yeah, treat it just as though it was an IV access. But yeah, warmer fluids is definitely better, cause these, these babies lose heat so quickly.
Yes, great. Thank you very much. I have a question here from Amanda.
I just lost it, sorry. Can I ask, why you use saline and not just water for direct smears? Oh, because that's a really good question.
It's because I found when I use water, the little beasties don't swim as much. So I found if I use saline, they swim better. And I want, I want to see them swimming because the, the, the number of cases that I've had referred to me, there were two kittens that were referred one day.
It was hilarious. And the referring vets are a great mate. And he had done the panels and everything, and they'd all been negative.
And they really, these two kittens were really healthy, but faecal incontinence. They were the ones owned by the human GP. And these kittens are bouncing around the room, two little Norwegian forests.
And one, the whole. Squirt of jelly. So I scooped that, and then the other one went as though to do some and then didn't do it.
So I literally just squeezed the kitten really gently and got this little fart out of it onto a glass slide. So I took my two glass slides and literally, a drop of warm saline, and I do warm it in my hands, or give it to a student who's got warm hands, my hands are pretty cold. And if you put warm saline, like, it seems to be if you shock the trichs at all, they stop swimming.
Which is why you want to make them to believe they are still in the catch, which is why you want to keep them in jelly. And then you literally microscope cover slip on, on the top, unless you want to mess up your micro your microscope, and you see them swimming, and it's so fabulous because, one of those kittens was All I could see was tri tricks. The other one, I could see Trittrix and Giardia.
So, when I, when I called the vet afterwards, I said, Yeah, we both have got tritricks and, and one of them's got Giardia. And he said, Oh, damn, how did you do that? I did.
I said, I was just lucky. I caught fresh poop, and it really comes down to the fresher the poop, the better. But it's a great test because it doesn't cost anything.
It takes more time to do it. And, it's always fun when we get one because you'll find us, you'll hear a call of poop sperm will go out, and it means come to the lab because we've got to try tricks under the microscope so everyone can see them swim. Oh, that's fantastic.
So many useful tips and and practical, advice for people. It's, it's wonderful. Thank you so much, Danielle.
We have a question from Joanna. Is it worth, giving B12 injection to any diarrhoea cases? I love B12.
What we now know, there's been a study in dogs, not cats, where they were using, Eococcus fiarum, and they showed in dogs, the B12 fell in those dogs. We don't know why, but that is why the probiotics are now being supplemented with B12, or we recommend that they are supplemented. So older cats, and certainly my more chronic diarrhoea, the first thing they get is B12s, and I'm always checking for B12.
But we had a great case recently came through neuro, a little cat, middle age and was seizuring. No. Sorry, older cat, 11 years old, and was seizuring, and that cat actually turned out to have exocrine pancreatic insufficiency with low B12, enough to cause seizuring.
So, I'm a great advocate for B12. Cats don't store it. They drop levels really quickly and you can result in haematological problems, neurological problems, and GI problems.
So yeah, any cat that is dehydrated or has been being diaries for any reason, I do like to keep topped up with B12. Fantastic, thank you very much. I'm aware we've gone slightly over on time.
Lots of interaction though from, participants, which is always great to see. So we'll just finish with one final question, from Ganine who's asked what fluid rate would you use with a sick eight week oldkitten, bolus owe or CRI. It really gets tricky.
We have the little tiny, you know, the little tiny drip systems that we can use with those, . I want it is, it is kitten to kitten dependent, how sick are they? If you can, I prefer a CRI if you can use it even a a strange driver, because the problem with the Ebolas hourly is that if you're using interosseous, then it clots and you kind of stuck.
And the same thing tends to happen because of the very low fluid rates. So it's always a problem. If you can keep a CRI going, I do prefer a CRI.
Perfect, thank you very much. I'm just gonna, sorry, one final question, because I promised James at the start of the webinar I would remember his question and I, I just forget it. So, for a 700 gramme, kitten, coccidiosis, can't necessarily afford the cock.
Should he just bite the bullet and buy it, or are there any alternatives? I always go with the. I really like the Baycocks.
I, I would actually, I would phone around other practises, because I bet you there is an, there is a practise that has got a, a, because you have to buy a huge container. And I'm sure another practise will give you a slodge of Baycocks and not charge you for it. Yeah, so I, I would do that because that's by far the most sensible thing.
You can try azithromycin, but yeah, and yeah, that's pretty safe in kittens, but it's not ideal. I, I would really try and get hold of the baycocks. Thanks, James.
Get a colleague. Thank you so much, Danielle, that's been a fantastic webinar. Thank you so much for your engagement and interaction at the end as well.
Thanks to all the attendees, and we'll see you on another webinar soon. It care
